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Application <br />-FOR- <br />Certificate ofAppropriateness <br />Historic PreservationCommission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 45601 <br />Mailing Addt ess: County -City Building, South Bend, Indiana 46601 <br />Phone -574-235-97% • Fax 574-235-9578 • Ema 1: SBSJCHPC0co.st Joseph in us <br />Website http://wwwstjasephcountyindiana.com/sjchp/index html <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY ENTRIES COMAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received S'Lt c,W'o Application Number 0Z.0 <br />Past Reviews: [;?'**YES (Mte of Wf Review) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />,� 9 )11A..�.. 14-00 � ❑ NO <br />[� Local Landmark &6cal Historic District (Namr) Ga <br />[] National Landmark ❑ National Register District {Name) <br />Certificate of Appropriateness: <br />Title: <br />[� Denied F1 Tabled n Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work. <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s):. A yt ri <br />Contractor(s)Name: fi" 1./('� 1 t' '„ ci t 'Y�> � � 1 C Or, 4 7 <br />Contract Company Name: 7 <br />Contractor Address: <br />City: Phone: <br />Current Use of Building'1�'Y <br />(Si`h t Family—Multi-Family— Commercial— Cnarrnmeat- Industrial — vocant — etc.) <br />Type of Building Construction: rP, <br />(Wood Fra me —Brick — Stone —Steel — Concrete— Other) <br />Proposed Work: ❑ In-kind ❑ Landscape [] New(Re <br />(�placement (not in-kind) E]Demolition <br />(more than one box my be dwird) t ' l <br />Description of Proposed Work: i" epbc W 'i(�-? n <br />J <br />Owner/Contractor: Fax: TEi-) — (D LO L-0 e-mail ' __ CAC. C4 <br />(M orkeWill <br />lcorrespond lath only one designer) <br />and/or - <br />— APPLICATION RE(21HREMENTS ARE LISTED ON REVERSE SIDE — <br />